Holiday Stress? The Shrink Is Always in on Your iPad

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Holiday Stress? The Shrink Is Always in on Your iPad

iCouch founders Jessica Rios and Brian Dear.

Photo: iCouch

The holidays aren’t always so happy. We get anxious about meeting cantankerous family members; stress over spending more than we should; and feel the loss of loved ones even more than usual. And yet in all the holiday hoopla, no one has the time to drive to a therapist and spend an hour telling her what’s weighing you down. So we turn to our laptops, iPads and smartphones for a different kind of therapy.

iCouch.me, a New York-based startup, offers a way to combine the two holiday modes, enabling a (hopefully) calming hour with a licensed psychotherapist via computers and mobile devices. Their tagline, "Your couch, your therapy," sums it up. “We’re about bringing therapy to individuals,” iCouch co-founder and CEO Brian Dear told Wired. “iCouch was built to help people, and to fill a shortage of mental healthcare.”

Dear and co-founder and therapist Jessica Rios came up with the idea while traveling in China. Rios’ friend was going through a rough patch and needed a professional to talk to, but couldn’t find a Spanish-speaking counselor quickly in China. Rios eventually put her friend in touch with a colleague in Mexico via Skype.

The session went well, and Dear and Rios figured they had stumbled onto a problem (and a market) that other patients, therapists, counselors and psychologists must certainly face. Skype was fine as an emergency fix, but what was needed, they decided, was a dedicated tool to connect patients with mental health professionals over the internet. That tool has become iCouch.

iCouch’s approach removes some of the common bottlenecks people face when considering a visit to a health professional: transportation, time, stigma and basic access. On iCouch, a customer pays an average of $85 per session and can "visit" his therapist in his pajamas through iCouch’s private video chat, says Rios. She finds that her patients, most of whom live in Asia and South America, open up more easily because they’re physically in a familiar environment.

iCouch itself doesn’t offer any clinical services. It’s just a storefront for empty appointment slots and a platform through which to organize therapists for time-thirsty clients. Joining iCouch is free. The company keeps a $20 “technology fee” from each paid session.

So far about 200 patients have joined, with about 35 booking a session at least once a month. Most iCouch patients seek help for relationship problems, anxiety, stress and depression. The platform works best for people who just need “casual therapy,” says Dear. It is not intended for people who need more regular mental health care, like patients with schizophrenia or multiple personality disorder.

iCouch “rigorously” screens therapists to make sure they don’t have a criminal or disciplinary history and verifies their licenses, degrees, and certifications, which provides patients with an added level of security, says Dear.

For counselors, iCouch is a way to gain new patients without the marketing costs or to counsel the patients they already have. “I have clients who start in person in my office, but because they travel for work, we do sessions online,” iCouch therapist Ivandro Monteiro told Wired in an email. “It’s easier to maintain a client-counselor relationship.” He treats patients in Portugal, Brazil, Angola and Cape Verde.

It's still very early days for the year-old startup. Right now the site only has about 30 active therapists, though Dear says there are about 110 approved in their database and that they’ve received more than 1,000 applications from therapists in the last 18 months. Most of their therapists are based in the U.S., while most patients live internationally, perhaps due to an even larger lack of access to mental health care abroad.

And while the concept seems to be resonating well with patients and therapists, it may be regulators who slow its growth as they grapple with interstate commerce, as well as privacy concerns. Healthcare professionals are already using technologies like Skype, Google+ Hangouts, and telepresence robots to virtually connect with patients and other colleagues. Whether deploying the kinds of tech that have become accepted in other industries runs afoul of regulations governing mental health is another matter.

Last year the American Psychological Association established a task force to develop telepsychology guidelines. But the laws on whether a therapist can "see" an out-of-state client via the internet vary.

“That’s a really tricky question,” says Lynn Bufka, assistant executive director of Practice, Research and Policy at the APA, the agency that represents some of the country’s psychologists. While the laws get clarified, Bufka recommends that providers get as clear a sense as they can of the law in their individual states.

For patients, knowing whether they’re talking to someone competent is also an issue. In many states, the word ‘therapist,’ a word iCouch uses throughout its site, is not a regulated term. “It’s one thing to go into an office and see a diploma hanging on the wall. It’s a very different thing in the virtual world,” Bufka added.

If you're feeling depressed just thinking about all the legalities, cheer up. Some states do allow interstate therapy on a short-term basis. So if the only available therapist is 1,000 miles away in another state, you might still be able to curl up on your couch and tell him your troubles on your iPad.